An Official Publication of Society of Pharmacovigilance, India.

Case Report

Serankottai induced contact dermatitis

during suthi process in Siddha -A case
report 1Research Officer (Siddha), 2Research
Associate, 3Assistant Research Officer
(Chemistry), Siddha Central Research
Juliet. L *1, Karthik raja.S.R 2 , Reena. V.L3, Aarthi. V 4, Sathiya Institute, Chennai, Tamilnadu, India.
4Research Officer (Siddha), Central

Rajeshwaran. P5 Council for Research in Siddha, Chennai,

Tamilnadu, India. 5Director i/c, Siddha
Central Research Institute, Chennai,
Tamilnadu, India

ABSTRACT
Background: In Siddha, the famous quote ‘Chukkuku pura nanju ,Kadukaiku aga nanju’,
reveals that most of the plants are adjoined with the toxic part /chemical which has to be
removed by the Suthi process before its medicinal uses. Any untoward medical occurrence
during treatment is the ADR (Adverse Drug Reaction). Contact dermatitis is one of the
common toxic symptoms/known ADR of most of the poisonous drugs. Serankottai
(Semecarpus anacardium nuts- SA nuts) is enormously used in Siddha medicine for various
challenging diseases like Rheumatoid arthritis, Cancer, Psoriasis, etc. This drug comes Corresponding Author
under poisonous herbs Schedule-E drugs and the expected adverse events are allergic
contact dermatitis, redness, severe itching, burning sensation, facial edema, anasarca and Juliet. L
Research Officer (Siddha), 2Research
anaphylactic reaction in extreme conditions. This study reports about the toxic signs Associate, Siddha Central Research
developed by Serankottai and its management through Siddha medicines. Institute, Chennai, Tamilnadu, India
Methods: Reporting of a different case, presented with Contact dermatitis during Siddha Copyright: © the author(s) and publisher. JPDS is an
purification method in Siddha manufacturing unit and the negative rechallenge of the official publication of Society of Pharmacovigilance,
India.
symptoms by Siddha antidotes were discussed.
Results: It is to report that, Serankottai induced contact dermatitis has been successfully This is an open access article
distributed in accordance with the Creative
managed by proper Siddha antidotes like Puli ilai kudineer (Tamarind leaf decoction) and Commons Attribution Non Commercial (CC BY-NC
Sengal podi ottradam (Brick powder Fomentation) as mentioned in Gunapadam Mooligai 4.0) license, which permits others to distribute, remix,
adapt, build upon this work non-commercially, and
Vagupu and Sattam Saarndha Maruthuvamum Nanju Maruthuvamum. license their derivative works on different terms,
provided the original work is properly cited and the
Discussion: Proper purification of Toxic plants reduces toxicity to end user. Siddhars have use is non-commercial
documented step by step SOP in Purification of Toxic Plants. They have also prescribed
remediation helping in Negative rechallenge. Here a case has been reported with Clinical
manifestations like Blisters and boils after getting consent as per the CARE Guidelines to
reveal the Negative rechallenge in pharmacovigilance.
Keywords: ADR, Negative rechallenge, Pharmacovigilance, Semecarpus anacardium-nut,
Suthimuraigal (Siddha purification process).

INTRODUCTION_____________________
Toxicity is the unwanted ill-effect during therapeutic/any use of a
substance. The toxic plant materials are also widely used by the
people especially more in rural population for various purposes like
Marking nut- used by washer man to mark on the cloth, Castor
beans-used for making castor oil from the seeds ,Rosary pea - used
as rosary beads and as jewelries, Oleander -widely used for its
beautiful flowers as ornamental flowers, Tobacco- a commercial non
food plant and those such plants are always very easily available on
the roadside or in the forests or among the dwelling places, the
people are more prone to their toxic illustrations. Likewise, the
pharmacies in which the Siddha and Ayurvedha medicines prepared
tempt to have more exposure to toxic plants, minerals and metals.
Pharmacy is the place where all the raw drugs are to purification,
drying, washing, burning, etc are performed. Pharmacies are assured
to deliver quality medicines. Pharmacy is a term to denote a shop or
store or other place where drugs are dispensed, measured or weighed
or mode up and supplied or where prescriptions are compounded; or
where drugs are prepared; or which has upon it or displayed within
it, or affixed to or used in connection with it. The poisons shall be
stored and clearly marked in red letters-Poison-in white background.
Any untoward medical occurrence during treatment with a
pharmaceutical product which does not have a causal relationship
with the treatment is the ADR (Adverse Drug Reaction).According
to the protocol of Pharmacovigilance programme, the toxicity or the
adverse effects of Indian plants should also be reported.

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J Pharmacovig Drug Safety Juliet. L, et al.

Hence the knowledge and also the practical usage of appropriate METHODS__________________________
antidote are very essential to handle them during their toxic exposure
especially in pharmacies and can be used as first line of treatment.
To counteract with the toxic effects, a peculiar antidote is required
for every poisonous plant. In Siddha, antidotes are used in different
ways, to eliminate the poison, to counteract its effect, to nullify its
toxin, and to resist its absorption.
Semecarpus anacardium Linn. (Family: Anacardiaceae) is one
among the poisonous plants and is distributed in sub-Himalayan
region, tropical and central parts of India. The nut is commonly
known as ‘marking nut’. (2, 3)The nuts are blackish, glossy, and Fig.No:1&2.Serankottai– Semecarpus anacardium Nuts
measure around 25–40 mm in length (Fig. 1b). They contain a dark
oil, known as ‘‘bhilawan oil’’, which has strong vesicant properties.
Many ailments like Asthma, Hemorrhoids, Warts, Chronic skin
diseases and Joint pain could be healed in indigenous medicine and
used as abortificient. The children use this nut as ornament
protection against an ‘‘evil eye’’ and its oil widely used in hair dye.
Urushiol is a primary irritant and it is a mixture of potent allergens.
Severe redness, itching, urticaria, papules, vesicles, bullae, or
erythema multiforme may persist for 2-3 weeks after its contact. (4) Fig.No:3.Cotyledon Fig.No:4. Cotyledon
Anacardic acid (which is closely related to Urushiol) and Bhilawanol Removing Process Removed SA Nut
which are responsible for allergic skin rash (5). Ghorpade et. al
presented a case report of developing contact dermatitis and A 28 year male Researcher while doing the purification process in
erythema while using oil of marking nut to relieve joint pain and he Semecarpus anacardium nuts has developed the allergic symptoms
documented a series of IV injections of Hydrocortisone acetate 100 like erythema, burning sensation , papular eruption and vesiculation
(9,10)
mg administered at 12-hour intervals over four days with topical . Tarry oil present in the pericarp of the fruit contains Anacardic
hydrocortisone acetate ointment, and hydroxyzine hydrochloride 10 Acid which is present in urushiol, might cause blisters on contact.
mg tab lets once per day for 20 days relieved the symptoms.(4) Verma The time duration for the presentation of allergic symptoms like
et al documented a case history of contact dermatitis when he used vesiculation, papular eruptions were 2 days after the exposure. The
marking nut as an external application as a treatment for Alopecia symptoms drained and gradually, vanished after taking the proper
areata and then resolved after taking Prednisolone 40 mg daily with antidotes like Puli ilai kudineer(10) 120 ml internally thrice a day and
a combination drug .(6) Ghorpade et al stated that a patient who topical fomentation with fried brick powder twice a day (10).The
suffered with edema in peri orbital region and facial lesions had allergic reactions disappeared within a week. The allergic dermatitis
exposure to marking nut fumes. He got improvement after taking has not replicated afterword till 6 months of exposure.
Hydrocortisone acetate inj. and hydroxyzine hydrochloride tablets, Table 1: Siddha Treatment Regimen for Serankottai
25 mg twice daily. (7) Jie Sen fok et al explained a case of anaphylaxis (Semecarpus anacardium) allergy:
due to Semecarpus anacardium nut after ingestion of a Hindi
Administration Medicine Dose Duration Pathiyam
traditional food given in a temple. He was relieved from symptoms
(Diet
after administration of Adrenaline. (8) Restriction)
Even though the contact dermatitis due to allergy of marking nut has Internal Puliilai 120 1 week Take more
been documented, here we discussed about a peculiar case of contact medicine kudineer ml- buttermilk
dermatitis developed during the purification process of marking nut (Tamarind thrice and curd
after getting consent as per the CARE guidelines. There exists a leaf a day
strong belief among the Siddha practitioners that after purification of juice)(10)
External Fomentati Twic 1 week Apply
this drug, the toxicity of the nut diminishes and the allergic
medicine on with e coconut oil
symptoms may not exist even after continuous exposure to the fried Brick daily after
purified nut. Also Siddha texts explained that those who are having powder fomentatio
elevated Azhal (Pitham) in their body or usually referred as Azhal placed in n therapy
udalinan are more prone to sudden or severe allergy . Serankottai is cotton
a primary ingredient of many Siddha herbo, herbo-mineral cloth (9)
preparations like Rasagandhi mezhughu, Idivallathy mezhugu, Moreover, during further purification process ,the allergic symptoms
Nandhi mezhughu, Serankottai nei, Mahavallathy legium ,Gandhi has not occurred after prior precautions along with intake of
vallathy, Sootha vallathy,Amirdha Gandhi kukil vallathy .etc which tamarind leaf decoction -60 ml once daily before suthi process.
are indicated for chronic diseases like Vadha diseases, Udhira vadha
sronitham, Mudaku vadham, Putru, Kattigal, Skin diseases,
Neurological diseases etc. These medicines are prepared after proper
suthi (Siddha purification process) explained in the text. Some
process insists in removing its cotyledon. While removing the
cotyledons as a part of suthi process, as mentioned in the texts,
Anuboga vaithya navaneetham and Gunapadam –mooligai vagupu,
the contact dermatitis has developed.
Fig.No:5&6. Contact dermatitis and erythema
caused by Serankottai.

Journal of Pharmacovigilance and Drug Safety Volume 16 | Issue 2 (Special Issue) | July-December 2019 32
J Pharmacovig Drug Safety Juliet. L, et al.

As per the Siddha text, “Vatham melitaal Mathuram Puli Uppu”, the
tastes sweet, sour and salt can be used for neutralizing the vitiated
Vatham. Hence Puli ilai (Tamarind leaves) because of its Sour taste,
act as the best choice of drug to minimize the ill effects caused in the
skin.
Contact dermatitis is the major ill effect noticed in the pharmacy and
it is a considerable issue while doing Suthi process. Even though,
there are many medicines which can revert these type of symptoms,
Fig.No:7.Boils and ulcers Fig.No:8. Boils caused in the this case have been treated differently with novel, appropriate
caused in the right forearm posterior part of right leg
antidotes mentioned in Siddha texts which are cost effective and
due to Serankottai during due to Serankottai during
suthi. suthi. easily available. These drugs can be used at the site of allergic
symptoms and these antidotes do not produce any further side effect
The toxicity symptoms (9)occurred as mentioned in Siddha system or adverse effect.
of medicine has been reported and the symptoms relieved after
administration of antidote as described in Siddha texts. CONCLUSION_______________________
The present work discusses a case report of contact dermatitis caused
by Serankottai during the purification process and the management
of Serankottai induced contact dermatitis through Siddha medication
in pharmacies. It has been concluded that it is hopeful in reversing
the toxic symptoms / known ADR of the Schedule E(1) drugs like
Serankottai through Siddha medication and antidotes. The purified
SA nuts do not cause any allergy when it is implicated in medicines.
Hence, further studies are required to validate the changes during the
purification process and analytical studies are to be carried out in
future research.

Fig.No:9. Tamarind leaf for Fig.No:10. Brick powder REFERENCES_______________________

decoction(internal medicine) fomentation on erythema
in rt forearm (external
medicine)
RESULTS & DISCUSSION_____________
The toxic symptoms may occur due to a mixture of phytochemicals
present in the toxic plants. Serankottai contains 90 % Anacardic acid
and 10% Cardol. The content of Anacardic acid which is closely
related to Urushiol may be reduced during traditional purification
methods, so that the Serankottai may be made effective before added
in medicine preparations. Thus reduction of the toxic tarry oil content
in Serankottai may reduce the toxic nature of the Nuts. Serankottai
is having the veriyam as hot and it is hot in nature. Hence when the
Pitham gets provoked (mainly in Pitha udalinan) ,the inflamed,
erythmatous skin rashes and boils appear. The Sage Theraiyar told
“Vathamalathu Meni kedathu” i.e. the imbalance in Vatham causes
skin diseases. Hence in this case, the provoked Pitham adjoins the
Vatham and causes the symptoms.
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